Beyond the Pelvis: Brain Metastases in Cervical Cancer – A Case Series from a Low-Middle-Income Country

Candra Novi Ricardo Sibarani,1 Dodi Suardi,1 Siti Salima,1 Nathania Nathania,2 Nicholas Adrianto3 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Obstetrics and Gynecology, Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 3School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Daerah Khusus Ibukota Jakarta, 14440, IndonesiaCorrespondence: Candra Novi Ricardo Sibarani, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, Email [email protected]: Brain metastases from cervical cancer are exceedingly rare and pose significant clinical challenges, particularly in low- and middle-income countries (LMICs), where access to advanced diagnostics and therapies may be limited. We report two cases of cervical carcinoma with brain metastases managed at a tertiary center in Indonesia, each illustrating distinct histopathologic subtypes and metastatic trajectories. The first case involved a 31-year-old woman with a grade II neuroendocrine carcinoma who developed intracranial recurrence 11 months after achieving a complete response to concurrent chemoradiotherapy. In the second case, a 46-year-old woman with poorly differentiated non-keratinizing squamous cell carcinoma developed progressive brain and pulmonary metastases during adjuvant radiotherapy. Both patients underwent craniotomy for gross total resection of symptomatic brain lesions, followed by adjuvant radiotherapy. The surgical intervention led to substantial neurological improvement in both cases, underscoring the role of symptom-directed neurosurgical palliation even in the setting of disseminated disease. These cases highlight the need for heightened clinical vigilance, individualized multidisciplinary management, and strategic application of available resources to improve outcomes in patients with central nervous system involvement from cervical cancer, especially within resource-constrained healthcare systems.Keywords: cervical cancer, brain metastasis, neuroendocrine carcinoma, squamous cell carcinoma